Prediction of protective sensory loss, neuropathy and foot ulceration in type 2 diabetes

• Published in: BMJ open diabetes research & care 2016, Vol.4 (1), p.e000163-e000163
• Main Authors: Paisey, R B, Darby, T, George, A M, Waterson, M, Hewson, P, Paisey, C F, Thomson, M P
• Format: Article
• Language: English
• Subjects: Pathophysiology/Complications
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2015-000163

ObjectivesTo prospectively determine clinical and biochemical characteristics associated with the development of peripheral neuropathy, loss of protective sensation, and foot ulceration in persons with type 2 diabetes mellitus (DM) over 7 years.Research design and methodsGraded monofilament (MF) testing, vibration perception threshold, and neuropathy symptom questionnaires were undertaken in 206 participants with type 2 DM without peripheral vascular disease or history of foot ulceration and 71 healthy participants without DM at baseline and after 7 years. 6 monthly glycosylated hemoglobin (HbA1c) levels and annual serum lipid profiles were measured during follow-up of those with DM. Incident foot ulceration was recorded at follow-up.ResultsTaller stature and higher quartiles of serum triglyceride and HbA1c levels were associated with neuropathy at follow-up (p=0.008). Remission of baseline neuropathy was observed in 7 participants at follow-up. 9 participants with type 2 DM developed foot ulcers by the end of the study, only 1 at low risk. Mean HbA1c levels were higher in those who developed foot ulceration (p